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What to Expect

About halfway through Tina Cassidy’s new chronicle of childbearing throughout the ages, I grew faint and pushed the book away. I’d managed to get through the account of a baby’s face mangled by an inept midwife in the English countryside, also an ill-fated forceps extraction and a tour of maternity wards corrupted by childbed fever. But the detailed description of a brutal 18th-century procedure called a “symphyseotomy” (you really don’t want to know), complete with an illustration of the long, hooked instrument used to perform it, proved too much to bear.

It was many mental miles away from a favorite pastime among pregnant women of my acquaintance: sitting glassy-eyed and transfixed by the television series “A Baby Story” on the Learning Channel. During that G-rated program, expectant mothers’ expletives are bleeped, naughty bits are tactfully blurred and swelling music celebrates the blessed event. Cassidy is determined to wipe the Vaseline from the lens. A former writer and editor for The Boston Globe, she embarked upon her research after the harrowing birth of her own son George, by emergency Caesarean section at a major Massachusetts hospital, following a prolonged and unproductive labor. Or so it was deemed by the overworked staff, a contingency that my Bradley Method instructor in Los Angeles, proselytizing for a birth medicated only by deep contemplative breaths, warned is all too common. A C-section under the most leisurely of circumstances, as for a stubborn breech baby, is far more unpleasant than the surgery’s widespread popularity among celebrities and upper-class Brazilians would suggest, but rather than feeling hot outrage at her ordeal, Cassidy chose cool-headed inspiration.

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Credit
David McLimans

What she discovered in her research is revolting, in both senses of the word. For a book about birth is also inevitably a book about death. In an appendix, Cassidy lists the lifetime risk of maternal mortality in countries around the world at the turn of the millennium; the United States, at 1 in 2,500, ranks worse than Qatar or Serbia. This despite the fact that a huge majority of American women deliver in a hospital, in a room “decorated perhaps with mauve wallpaper and pretty beach scenes,” she notes, “on a bed that can — if necessary — be wheeled into the operating room, surrounded by machines, and attached to electrodes and a catheter that drips anesthetic directly to the spine.” Viewed with such clinical detachment, modern childbirth protocol doesn’t seem that distant from the Victorian era, when women in travail begged to be chloroformed like kittens. Later, feminists agitated for the right to sink into something ominously and glamorously called Twilight Sleep, a cocktail of scopolamine and morphine first distributed at a clinic outside the Black Forest that erased all memories of the proceedings from its straitjacketed, thrashing recipient. It was a kind of obstetrical “Eternal Sunshine of the Spotless Mind” that persisted until the 1970’s. Now the reactive vogue for natural lying-in (or squatting, as the case may be) has been co-opted by a litigation-wary medical establishment. Meaning: token encouragement of popular earthy accouterments — rubber balls for bouncing, hot tubs for soaking, doulas for emotional support, handwritten “birth plans” — while nurses offer epidural anesthesia with the enthusiasm of Washington Square dope pushers and doctors rush to the knife at the slightest questionable blip from the electronic fetal monitor.

Still, things could be a lot worse. At least doctors these days soap up between internal examinations. Husbands who complain that their newfangled presence as “coaches” in the delivery room quashes the libido, as did some men quoted by Dr. Keith Ablow in a much-discussed column for the Health & Fitness pages of The New York Times a year ago, should be grateful they aren’t members of the Huichol tribe of Mexico, whose laboring mothers tie a string around their partners’ testicles, yanking enthusiastically as each contraction peaks. Warily, through parted fingers, I peeped at a chapter called “Tools and Fads,” featuring an assortment of medical equipment laid out like so much cutlery (“undated basiotribe, used for crushing the fetal skull”) and a French parturition chair with hand grips that looks like it belongs in Madame Tussauds’ Chamber of Horrors. And while we’re on the topic of C-sections, all hail the desperate woman, also Mexican, who in 2002, after a few stiff drinks, administered one to herself with a kitchen knife. (Both she and the baby survived.) Whatever happened to the stork showing up with a little ribbon-tied bundle in its beak?

Cassidy’s natal narrative hews closely to real-life events; a few literary examples (“Lawdy, Miz Scarlett!”) might have enriched it even further. And maybe it wasn’t strictly necessary to include a recipe for placenta pizza topping (from a 1983 issue of Mothering magazine). Still, there’s a collective, willful amnesia about birth — as if it’s an alien visitation, rather than the normal order of things — that has been begging for her clear-headed dissipation. We want it to be meaningful and we want it to be mercifully brief. This book is both.

Alexandra Jacobs is an editor at The New York Observer.

A version of this review appears in print on , on page 715 of the New York edition with the headline: What to Expect. Today's Paper|Subscribe